Gavin Howe
Nursing is a highly regulated profession, with nurses required to adhere to a variety of laws and regulations in their day-to-day work. These laws govern the practice of nursing and aim to protect the public from unsafe practitioners. Nurses are expected to have a clear understanding of the legal framework within which they operate, including public and private law, and any violations can result in serious consequences. Public law can be further divided into constitutional, statutory, administrative, and criminal law. Nurses must also be aware of federal laws such as HIPAA, which protects sensitive client health information, and state laws such as the Nurse Practice Act (NPA), which governs nursing practice in each state. Understanding these laws is essential for nurses to provide safe and ethical care to their patients and avoid legal repercussions.
| Characteristics | Values |
|---|---|
| Public Law | Constitutional, Statutory, Administrative, Criminal |
| Constitutional Law | Rights, privileges, and responsibilities established by the U.S. Constitution |
| Statutory Law | Written laws enacted by federal or state legislature, e.g., Nurse Practice Act, Health Insurance Portability and Accountability Act (HIPAA) |
| Administrative Law | Rules and regulations created by government agencies, e.g., state Nurse Practice Act |
| Criminal Law | Illegal actions, felony, misdemeanor, Medicare fraud |
| Private Law | N/A |
| Civil Law | Torts, contract laws, malpractice, negligence, patient confidentiality |
| Torts | Civil wrongs or injuries, breach of legal duty, legal rights of patients, responsibilities of nurses |
| Malpractice | Duty, breach of duty, harm, causation, compensatory and punitive damages |
| Negligence | Failure to exercise ordinary care, creating unreasonable risk |
| Good Samaritan Law | Protections against negligence claims for aid rendered outside clinical settings |
| HIPAA | Privacy Rule, Security Rule, protecting electronically protected health information |
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What You'll Learn
Malpractice and negligence
Nursing regulation through the Nursing Practice Act (NPA) is a state-initiated effort to standardise laws that regulate nursing practice. The NPA emphasises the accountability of all nurses in providing and improving safe client care. It provides nursing practice standards and a code of conduct for the continued privilege to practice nursing.
Nurses are responsible for being aware of the laws and regulations affecting their nursing care in the state(s) in which they are practising. If allegations are made regarding a nurse's professional conduct or provision of client care, the excuse "I did not know" does not hold up in a court of law or with a state's Board of Nursing.
Negligence and malpractice are types of unintentional torts. Negligence is the failure to exercise the ordinary care a reasonable person would use in similar circumstances. Negligence results when a nurse fails to provide reasonable care due to oversight, inattentiveness, or ignorance. This lack of care provision does not occur intentionally and may be attributed to carelessness. A slow response to a patient's alert that results in injury or harm, such as a patient falling, can lead to negligence.
Malpractice is a specific term used for negligence committed by a licensed professional. It occurs when a nurse fails to meet the standard of care expected from individuals within a profession while being aware of their actions or lack of action and the potential outcome, yet continues the behaviour. Nursing malpractice can result in catastrophic harm to patients. Malpractice cases in a court of law may set compensatory and punitive damages against a nurse, but only the board of nursing may discipline a nurse for substandard practice.
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Nurse Practice Act (NPA)
The Nursing Practice Act (NPA) is a set of laws and regulations that govern the practice of nursing in the United States. Each state and territory in the US has its own version of the NPA, which is then interpreted and enforced by the respective state or territorial nursing board. These boards, often referred to as Boards of Nursing (BON), are responsible for regulating the practice of nursing care and have the authority to discipline nurses who violate the nursing laws and regulations.
The NPA provides guiding principles and standards for the scope of nursing regulation. This includes defining the terms used in the law, outlining the composition of board members, setting nursing school educational program standards, defining the scope of nursing practice, overseeing licensure processes, and providing grounds for disciplinary actions for violations. The NPA aims to protect the public from unsafe nursing practices and hold nurses accountable for providing and improving safe client care.
One of the key aspects of the NPA is its focus on patient safety and the prevention of malpractice. When a patient or their family sues a nurse for substandard care or malpractice, the BON investigates the complaints. The elements that must be proven in a court of law include duty, breach of duty, harm or injury, and causation. While malpractice cases may result in compensatory and punitive damages against the nurse, only the BON has the authority to discipline a nurse for substandard practice.
Additionally, the NPA provides clear definitions of the nursing scope of practice, ensuring that nursing care is aligned with the nursing process of developing a plan of care for patient advocacy. It also establishes standards of practice for all nursing levels, including PN/VN (practical nurse/vocational nurse), RN (registered nurse), and APN (advanced practice nurse). The NPA is accessible to the public, and licenses can be verified online through state-sponsored verification systems.
In summary, the Nurse Practice Act (NPA) is a comprehensive set of laws and regulations that govern the practice of nursing in the United States. It provides guiding principles, defines the scope of practice, sets standards for nursing education and licensure, and holds nurses accountable for providing safe and ethical care to patients. The NPA is enforced by state and territorial nursing boards, ensuring that nurses adhere to the established standards and disciplinary actions are taken when necessary.
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Administrative law
The NPA is a set of laws that govern the practice of nursing in each state and territory of the US. The NPA is interpreted and enforced by state and territorial nursing boards, which have the authority to regulate nursing care and enforce nursing laws. The NPA provides guiding principles for the scope of nursing regulation, including defining terms, board composition, nursing education standards, the scope of nursing practice, licensure processes, and disciplinary actions.
Nurses are responsible for being aware of the laws and regulations affecting their nursing practice in the state or territory in which they are working. This includes familiarity with the NPA, as ignorance of the law is not an excuse for non-compliance or substandard nursing practice. The NPA is publicly accessible, and nurses can verify their licenses through a state-sponsored verification system.
The Board of Nursing, as the administrative arm, enforces the NPA and provides guidance for nursing practice in each state. Registered nurses are expected to know and practice under the NPA, and deviations from the NPA can result in license suspension or revocation. For example, in the state of Maryland, nurses found to deviate from the NPA may have their RN license encumbered or revoked.
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Criminal law
In the healthcare sector, criminal law is applied in cases of serious wrongdoing, such as fraud, diversion of drugs, or the intentional or reckless killing of elderly or vulnerable people. For example, a nurse may face criminal charges, in addition to civil charges, for committing fraud by documenting interventions that were not performed or altering records to conceal mistakes. Criminal penalties may also be imposed for violations of the Health Insurance Portability and Accountability Act (HIPAA), which protects sensitive client health information. HIPAA violations can result in fines and jail time for malicious or personal gain intentions.
Nurses must also be aware of state laws regarding the confidentiality of child and adolescent care. They should exercise caution in their oral and written communication to avoid defamation of character, which is a form of intentional tort. Intentional torts are wrongs that the defendant knew or should have known would be caused by their actions. Other examples of intentional torts in the nursing context include assault, battery, false imprisonment, and breach of privacy or client confidentiality.
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Civil law
There are two categories of torts that affect nursing practice: intentional torts and unintentional torts (also referred to as negligent torts). Intentional torts include acts such as intentionally hitting a person, while unintentional torts include errors such as failing to follow agency policy. Negligence, a type of unintentional tort, occurs when a person fails to exercise the ordinary care that a reasonable person would use in similar circumstances. For example, a nurse may be negligent if they fail to follow the standard procedures for providing patient care, resulting in harm or injury to the patient.
Malpractice is a specific type of negligence committed by a licensed professional, such as a nurse. To prove malpractice in a court of law, several elements must be established, including duty, breach of duty, harm or injury, and causation. Duty refers to the existence of a nurse-client relationship, which can be established in various ways, such as through inpatient care or by volunteering services outside of a clinical setting. Breach of duty occurs when the nurse fails to uphold their professional obligations, such as by providing substandard care. Harm or injury refers to any physical, emotional, financial, or other type of detriment suffered by the client. Finally, causation must be demonstrated to show that the harm or injury was a direct result of the nurse's breach of duty.
In civil lawsuits, plaintiffs must prove that the nurse owed a duty to the client, breached that duty, and that the breach resulted in damages. The plaintiffs then request repayment for their losses, which can include various types of injuries, such as physical, emotional, or financial damages. Civil cases in nursing often aim to gain financial support for medical costs, lost income, pain, suffering, and disability caused by the nurse's actions or omissions.
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Frequently asked questions
The NPA is a set of regulations with the full force and effect of law, which governs the practice of nursing. Each state or territory in the US has its own version of the NPA, which is then interpreted by each state and territorial nursing board. The NPA provides guiding principles for the scope of nursing regulation, including defining terms, nursing school standards, nursing practice scope, and licensure processes.
There are several types of public law, including constitutional, statutory, administrative, and criminal law. Nurses need to be aware of these laws and how they affect their practice. Constitutional law refers to rights and responsibilities under the US Constitution, such as the right to privacy. Statutory law is written law enacted by federal or state legislatures, such as the NPA. Administrative law is created by government agencies and includes rules and regulations to protect the public, such as the state NPA. Criminal law deals with crimes and their prosecution, such as Medicare fraud.
Malpractice is a type of unintentional tort, or civil wrong, committed by a licensed professional. Nurses can be sued for malpractice if they breach their duty to a patient, causing harm or injury, and this breach results in damages. Negligence is a type of tort that applies to any person who fails to exercise ordinary care, creating an unreasonable risk of injury or damage. Malpractice is a specific term for negligence committed by professionals.
